Role of the notched unipolar electrogram in guiding catheter ablation of frequent premature ventricular contractions originating from the ventricular outflow tract

Abstract

Objective To investigate the value of a notched unipolar electrogram (N-uniEGM) in confirming the origin of premature ventricular contractions originating from the ventricular outflow tract (VOT-PVC) during mapping and ablation procedures. Methods This retrospective study enrolled consecutive patients with symptomatic idiopathic frequent VOT-PVCs that underwent radiofrequency ablation. The characteristics of the uniEGM of the successful ablation targets were analysed. N-uniEGM was defined as the uniEGM presenting a QS morphology with ≥1 steep notches on the downstroke deflection. All patients were followed-up for 3 months post-ablation. Results The study enrolled 190 patients with a mean ± SD age of 49.0 ± 15.3 years. N-uniEGMs were recorded in 124 of 190 (65.3%) patients. The N-uniEGM distribution area was limited to a mean ± SD of 0.8 ± 0.4 cm2. N-uniEGM showed consistency with the outcomes of activation mapping and pace mapping. Patients with an N-uniEGM had an ablation success rate of 98.4% (122 of 124) and their ablation times were significantly shorter than those without an N-uniEGM (7.6 ± 3.8 s versus 15.8 ± 8.8 s, respectively). The sensitivity and specificity of N-uniEGM in predicting successful ablation of VOT-PVCs were 72.6% and 91.7%, respectively. Conclusion N-uniEGM was a highly specific and moderately sensitive predictor of successful radiofrequency ablation in patients with VOT-PVCs.

Electrograms in redo-ablations: Near-field or far-field or both?

“… A negative concordance pattern (NCP) during the initial 20 ms of both uni-EGM and bi-EGM can help to localize the origin of focal ventricular arrhythmias [ 3 ]. Notched uni-EGM (defined as the uni-EGM presenting a QS morphology with ≥1 steep notches on the downstroke deflection) was a highly specific and moderately sensitive predictor of successful radiofrequency ablation in patients with VOT-PVCs [ 9 ]. Finally, unipolar recording can indicate a VT originating from epicardium or mid myocardium when all the early sites of activation record a small r wave [ 4 ].…”

“…Notched uni-EGM (defined as the uni-EGM presenting a QS morphology with ≥1 steep notches on the downstroke deflection) was a highly specific and moderately sensitive predictor of successful radiofrequency ablation in patients with VOT-PVCs [ 9 ].…”